I stumbled upon this list on the Internet yesterday and had to publish a link to it.  Some of the abbreviations are hilarious, some disgusting,  and most very appropriate. My new favourites include:

 AALFD – Another A**hole Looking For Drugs

240 grain Injection  – 44 calibre magnum wound

Ass Grapes – badly thrombosed or strangulated haemorrhoids

BSS – Bilateral Samsonite Syndrome: patient admitted with both their bags packed in preparation

Chart Dehiscence - to drop a patient chart and everything falls out.

 DTMA – Don’t Transfer to Me Again

FABIANS – Felt Awful But I’m Allright Now Syndrome

AST – Assuming Seasonal Temperature (dead)

FOOBA – Found On Ortho Barely Alive

Genital hurties – genital herpes

HIBGIA – Had it before, got it again

And my favourite nursing order of all:

PBABLTO – Pine Box at Bedside, Leave Top Off

Necessity is the mother of invention. Health care workers are always inventing little things with whatever is around (MacGyver-style) to make our lives (and our patients’) easier. Here is such an example. A patient came in the other day with massive ascites from hepatic failure and required a paracentesis (draining the fluid from the abdomen). Usually, you just attach to tubing to vacuum bottles that automatically sucks the fluid into them. They are usually in short supply though. Also, you often have to drain a lot more than a litre of two off these folks (this guy had 8 litres taken off – and was admitted for some gentle IVF to avoid post procedural hypotension) so you need a lot of bottles. I remember just letting the excess liquid drip by gravity into an open container – but Man, it is SLOW. What if you could just somehow attach the IV tubing (which is used to connect the angiocath or needle that is inserted into the abdomen) from the patient indirectly to wall suction? The tubing is too thin to attach directly to the container. Here is my colleague’s invention. She and the RN attached the 3cc syringe to the input of the suction container (luckily you can just jam the back end into the opening) and removed the plunger from it. They then attached a three-way stopcock to the end so that the flow of fluid could be regulated with the lever (modifying the suction strength and the rate (via the stock cock) optimises the flow so that you can achieve rapid suction without collpasing the thin IV tubing).

Worked brilliantly!

Sometimes, it order to avoid a costly and unnecessary work up, you have to have an intervention with a patient. Not a “stop drinking” or “stop cocaine” intervention, but a “you don’t need any more testing, you will get better on your own” one. I have a pretty good success rate with these but it comes at a price. You have to spend an inordinate amount of time doing it. The other day I convinced one family that mom did not need her second CT scan for her third visit in a month for benign positional vertigo. I had to spend 15 minutes explaining the disorder,the treatment, and most importantly, what her expectations for recovery should be (ie, it won’t get better instantly, even with antivert). I got backed up with other patients but felt good that I avoided another run of blood tests and head CT. Later the same shift I spent even more time telling a healthy young guy why he did not need another EKG, CT, and MRI, and or repeat blood work for his second episode of vasovagal syncope. Trying to explain the autonomic nervous system in a way that a lay person can understand can be challenging enough – but when they ask a hundred questions, before you know it, you are 5 more patients in the hole. Well, at least that was towards the end of my shift and the guy felt “educated” enough about the condition to use the term “micturition syncope” in dinner conversation. And, I saved his health plan a crap load of money!